Logging On for Second Opinions

It’s always a good idea to get a second opinion when a health-care provider makes a serious diagnosis or treatment plan, or advises you to undergo anything more than a simple procedure. These days, this trust-but-verify practice is easier than ever.

As reported in The Wall Street Journal, (WSJ) patient demand for online second-opinion services is growing, and several established medical centers offer it, as well as independent operations. The paper said that as many as 1 in 5 patients seek second medical opinions, and for some disorders it’s more than 1 in 2. Specialties where second opinions are more likely include oncology, neurosurgery, cardiology and orthopedics, although those might not be addressed best via the Internet.

Medicine is capitalizing on the growing consumer market, as Dr. Gregory Pauly, chief operating officer of the Massachusetts General Physician Organization at Massachusetts General Hospital told the WSJ. His hospital’s online second-opinion service is 8 years old. Last year, it handled about 10,000 cases; five years ago, it was only 1,000. A second online opinion at Mass General costs between $500 and $5,000 depending on the case.

Cleveland Clinic’s online second-opinion service, MyConsult, is more than 10 years old, and is especially popular with corporate clients and patients who live far from the clinic. It charges $565 for a consultation and $745 if it includes a pathology review. Its reviewing doctors disagree with the original diagnosis in about 11 of 100 cases. It advises moderate changes to treatment in about 1 in 4 cases, and major changes in 16 in 100.

Many insurance plans cover the cost, or some of it, of second opinions, and some plans require a second opinion for certain procedures, such as surgery.

The website SecondOpinionExpert Inc., launched a few months ago, providing second opinions for $300 and a video conference consultation for another $200. Its fees, according to the WSJ, generally aren’t covered by insurance plans.

The WSJ referred to the work of Dr. Hardeep Singh, a patient safety researcher at Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston. He studied data from Best Doctors Inc., an independent service that offers second opinions online to companies and insurance carriers. His team reviewed 6,791 second opinions and found changes in diagnosis in about 15 in 100 cases, and changes in treatment more than one-third of the time.

About 6 in 10 of the patients reviewed followed the recommendations of the second-opinion practitioner. But, as Singh told the WSJ, “we don’t know whether the ultimate diagnosis for these patients ended up being the correct one.”

The WSJ noted, as have we,
that “second opinions often result in different diagnoses or treatments.” As the complication or severity of the problem increases, so does the value of a second opinion. A first opinion might be incorrect, but even if it isn’t, the person offering it might neglect to discuss all the options to address it. And if a second opinion confirms the first, it’s a trust-builder with your practitioner.

Second opinions also can introduce patients to practitioners with more experience or expertise than the person who gave the initial opinion; the second person the patient consults might have similar experience, but a better record of outcomes. A second opinion might save money and resources if it shows that a recommended treatment is unnecessary or unlikely to make a difference. It might offer less invasive treatment, or one with fewer side effects.

Beth Moore, executive vice president of program strategy for the Patient Advocate Foundation, told the WSJ, “You don’t always know what’s available unless you seek a second opinion,” and that in-person second opinions are better in cases that might require sophisticated tests, such as with rare diseases. When two doctors have opposing recommendations, she recommends getting a third or even fourth opinion.

If the online approach is appropriate for you, it often saves time. As the WSJ explained, patients request their medical records be sent to an online second-opinion service, which is a bonus for people who live far from major academic centers that cover a wide range of physician specialties. If you opt for this method, make sure your insurance covers online opinions – many don’t. And if a second opinion makes you want to switch practitioners, make sure the new one is in your insurance company network.

As the Wall Street Journal recommends:

Second opinions generally aren’t necessary for easy-to-diagnose cases, such as sinusitis or shingles, unless the treatment isn’t working and the symptoms don’t diminish as expected.

Second opinions are a good idea for conditions in which a diagnosis is unclear, involves a serious or rare condition or when treatment options are risky.

Be open and honest with your primary physician that you want another viewpoint. Most doctors expect, even encourage second opinions. That builds communication if you later need the experts to discuss your case.

If possible, seek a second opinion from a doctor or specialist at a different institution or network from the first consult. “Institutional cultures are real,” said the paper, “so it’s good to get an outside and different perspective.

If your first and second opinions differ, get another. But getting more than four probably will just be confusing, so don’t go “doctor shopping” simply because you don’t like what you hear.

For some conditions, an in-person visit is best. If your condition is rare, complicated or advanced, online second opinions aren’t your best option.

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